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Saint-Hyacinthe Research and Development Centre's Industrial Program: Industrial project application form

You can use either the Web version or the PDF version (55.5 KB) of the form.

Please complete, print and send the form by mail.

Please mail to:

Saint-Hyacinthe Research and Development Centre
Agriculture and Agri-Food Canada
3600 Casavant Boulevard West
Saint-Hyacinthe, Quebec
J2S 8E3
industrial-program@agr.gc.ca

Commercial and Confidential Information

Protected once completed

1. Corporate Information

Legal name and operating as name:

Address

Unit/Suite/Apartment

Street number

Number suffix

Street name

Street type

Street direction

PO Box or Route Number

Municipality (City, Town, etc.)

Province

Postal code

Do you have an account with Agriculture and Agri-Food Canada?
Yes (go to next question)
No (see note 2)

Was there transactions done within the last 2 years?
Yes (see note 1)
No (see note 2)

Notes:

Indicate your account number:

Your credit will be reevaluated. Credits conditions could be modified.
You have to open an account with Agriculture and Agri-Food Canada. To initiate the process, fill out the form Customer Credit application and join it to this application. If you need a copy of the form, contact industrial-program@agr.gc.ca.

2. Industrial Project

Project title

Brief description of project

Project objectives

Access time required to the Saint-Hyacinthe Research and Development Centre (in days):

Planned project schedule:

Starting (YYYY-MM-DD)

Ending (YYYY-MM-DD)

Will you be using hazardous materials as defined by the Workplace Hazardous Materials Information System (WHMIS)?
Yes
No
Don't know

Constraints (indicate any factors which may affect the progress of your project, including the non-desirability of a competitor’s presence at the Saint-Hyacinthe Research and Development Centre):

Required Facilities and Services

Pilot plant
Laboratory
Industrial office

Specify equipment and/or instruments (pilot equipment list available):

Sensory evaluation
Ionization
Scientific and/or technical support

Specify nature of support required

Resources Provided by the Firm to Carry Out this Project

Personnel: Person responsible for the project

Family name

Given name

Title

Telephone number

Extension

Fax

Other staff assigned to the project

(Use another page if there are more than two other persons)

Family name

Given name

Role

Family name

Given name

Role

Material (including raw ingredients)

Description and quantity

Estimated value (in dollars) (A)

Other (for example equipment rental)

Estimated value (in dollars) (B)

Total (in dollars) (A+B)

3. Release and Obligations

In the event of acceptance of this application, the Firm agrees:

that, except for risks arising from the gross negligent acts or omissions of Agriculture and Agri-Food Canada, its presence at Agriculture and Agri-Food Canada’s Saint-Hyacinthe Research and Development Centre (Saint-Hyacinthe RDC), including the presence of its employees, collaborators, representatives and equipment, will be at its own risk;
to waive any claim that it could otherwise make against Agriculture and Agri-Food Canada for any illness or injury (including that resulting in death) or any material loss suffered while present at Saint-Hyacinthe RDC and to pay any compensation which might be payable to third parties as a result of such illness, injury or loss, except to the extent such illness, injury or loss arises from the gross negligent acts or omissions of Agriculture and Agri-Food Canada;
to release Agriculture and Agri-Food Canada of any liability alleged by a third party for the infringement of any intellectual property rights (trade secret, patent, copyright, etc.) during the Firm’s activities at Saint-Hyacinthe RDC;
to respect all government rules and regulations related to the use and disposal of products, by-products and wastes originating from its project, including hazardous materials;
not to knowingly introduce to the Saint-Hyacinthe RDC, materials which may present risks of chemical, microbiological contamination;
to assume all the direct expenses incurred in the execution of its project, such as, but not limited to, the following: modification, installation, transportation, calibration and restoration to their original condition of the equipment and project site used during the execution of the project;
to assume the costs of the Saint-Hyacinthe RDC’s services according to the effective fee schedule. These costs are subject to the Firm's approval before the beginning of the project (D04/002);
to respect the conditions governing credit (A5119-E);
to respect all the rules and procedures governing its presence in the Saint-Hyacinthe RDC’s facilities.

Agriculture and Agri-Food Canada agrees:

to provide a safe working environment to the Firm;
to respect confidentiality; all results belonging exclusively to the Firm.
that the Saint-Hyacinthe RDC’s equipment and instruments required for the execution of the project will be operational and in good repair;
to provide the training required to enable the Firm to execute its project in a safe manner;
to permit access to the required infrastructures and support, in accordance with the work plan developed by the two parties; and
submit a cost estimate for the Firm’s approval before the beginning of the project.

In witness whereof, the authorized representative of the Firm has signed:

Signature:

Date (YYYY-MM-DD)

Name and title of the Firm's representative